surgical techniques

Question 1

levels of amp based on

Answer 1

vascular disease - lvl selected based on anticipated viability

postop fx - most distal possible

disarticulations - most wont perform at knee or ankle joint due to poor circulation

traumatic amps - lvl determined based on nature of injury

Question 2

myoplasty

Answer 2

Attachment of anterior and posterior compartment muscles to each other over the end of the bone
Better in the presence of ischemia

Question 3

myodesis

Answer 3

Anchoring of muscles to bone

Increased stability and muscular control

Question 4

open amp vs closed amp

Answer 4

open is Utilized if infection present or not enough tissue to provide good closure initially

closed is where skin flaps wrap the leg like a present either equal or post longer

Question 5

skin flaps meet in the middle closed amputation

Answer 5

Skew sagittal flaps – midial lateral flap that meets in the middle

Question 6

shortest lvl of fx for BKA

Answer 6

at the tibial tubs

Question 7

the fibula in a BKA is

Answer 7

gen cut 1 cm shorter

Question 8

why is ACE wrapping important

Answer 8

so we don’t get a light bulb shaped lib and keep a nice cylinder

Question 9

AKA is common in

Answer 9

people with poor circulation

or gangrene foot/ankle

Question 10

Reasons for choosing transfemoral v transtibial include

Answer 10

Trauma
Gangrene that has extended to knee
Circulatory status indicating poor chance of healing at transtibial level

Question 11

postitioning for AKA pts right after surgery

Answer 11

EX and AD

Question 12

why do the limbs what to go into FL and AB

Answer 12

the shorter the femur is the more mechanical advantage the quads have and the more AD lost

Question 13

common issues post op with all amp

Answer 13

pain 
Wound healing
Fluid collection/edema
Heterotrophic ossification
Trauma

Question 14

common issues post op with transtibial

Answer 14

knee FL contracture

Question 15

common issues with transfemoral post op

Answer 15

Hip adductor roll – have to get the ACE wrap all the way to the groin
Hip flexor contracture
Hip abduction contracture
Glute weakness

Question 16

what is a contracture caused by

Answer 16

Immobility which leads to connective tissue proliferation into the joint space

Question 17

what can a contracture lead to

Answer 17

Can lead to: pain, pressure ulcers, further immobility and functional deficits

Question 18

what is osseointergration

Answer 18

where they connect the prosthetic straight to the femur and it takes many surgeries but no need for a socket

Question 19

what are the downsides of osseointergration

Answer 19

Multiple surgeries
Prolonged period of no ambulation
Risk of fracture, infection
Reduction in activities that require high torque or axial stress
Not well known in the U.S.

Question 20

heicorporectomy

Answer 20

below waist amputation, B LE amputated

Question 21

transpelvic amp

Answer 21

amputation of portion of the pelvis and lower extremity

Question 22

hip disarticulation

Answer 22

: amputation through hip joint capsule including the entire lower extremity

Question 23

knee disarticulation

Answer 23

Inability to provide adequate transtibial residual limb secondary to trauma

Knee flexion contracture >45 degrees,

Infection of soft tissue close to knee joint

Congenital deformities
Rarely used in individuals with vascular compromise

Question 24

ankle disarticulation amp

Answer 24

also called symes amp

preserves the heel pad

used for severe foot trauma

must have circulation

Question 25

main take aways for surgical procedures

Answer 25

Reason for amputation is key for treatment Level and amputation type are important for rehabilitation Limb shape is vital to prosthetic use, and therefore function Expect impairments in muscle length, strength, and motor control – joint position following amputation surgery Don’t forget about co-morbidities – HTN CVA `

Question 26

psychological considerations for positive adjustments after amp is

Answer 26

premorbid coping mech how well they could handle stress and unexpected life events before ths

Question 27

4 stages of emotional adjustment

Answer 27

1st prior to surgery – 1st stage Immediately after surgery - second After initiation of postoperative program - third Reintegration into functional lifestyle - forth

Question 28

immediately after surgery

Answer 28

may express relief or grief is traumatic - could be euphoric or overly cheerful

Question 29

acknowledgement phase

Answer 29

Overwhelming with information may lead to greater helplessness Private or group sessions with individuals who have made successful adjustments may be helpful Feelings can alternate between hopelessness, despondency, bitterness and anger

Question 30

adaptation concerns

Answer 30

appearance Fx unrealistic expectations

Question 31

one thing you should ask your pt that is rarely asked

Answer 31

sexual issues - may be affected

Question 32

phantom sensation

Answer 32

Sensation that the absent limb is still there in some form most distal usually felt

Question 33

recent theory on phantom sensation

Answer 33

sensation and pain originate in cerebrum | Current research includes looking into sensory reintegration and reorganization

Question 34

phantom pain

Answer 34

Phantom pain | Cramping or squeezing sensation, shooting pain or burning pain

Question 35

most pop tx for phantom pain

Answer 35

mirror box system

Question 36

age considerations for amp children

Answer 36

Parental adjustment is important because greatly influences the child’s adjustment Children adapt fairly easily to the use of orthotic or prosthetic Comfort is most important Early adolescence may fear rejection and social ostracism Compliance may also be an issue - teens Involvement in sports programs is extremely helpful

Question 37

age considerations for amp elderly

Answer 37

maintaining independence May be viewed as the end to an active lifestyle Learning to use artificial limb or orthosis may be slow and discouraging consider comorbidities

Question 38

considerations for caregivers

Answer 38

Can be stressful for caregivers as well Important to have an awareness of caregiver concerns Can they physically handle caring for the patient Provide time for caregiver to ask questions as well

Question 39

main takeaways for phychosocial

Answer 39

Complex issues require team approach Pre-amputation coping mechanism can determine psych outcome Trauma v. Vascular Not just the patient Children adjust quickly, but compliance can be an issue throughout teen years